Using the ACLS Bradycardia Algorithm for Managing Bradycardia
The ACLS Bradycardia Algorithm outlines the steps for assessing and managing a patient who presents with symptomatic bradycardia. It begins with the decision that the patient’s heart rate is < 60 bpm and that is the reason for the patient’s symptoms.
Steps
- Decision: Heart rate is < 60 bpm and is symptomatic.
- Assess and manage the patient using the primary and secondary surveys:
- Maintain patent airway.
- Assist breathing as needed.
- Administer oxygen if oxygen saturation is less than 94% or the patient is short of breath.
- Monitor blood pressure and heart rate.
- Obtain a 12-lead ECG.
- Review patient’s rhythm.
- Establish IV access.
- Complete a problem-focused history and physical exam.
- Search and treat possible contributing factors.
- Answer two questions to help you decide if the patient’s signs and symptoms of poor perfusion are caused by the bradycardia (see Figure 2).
- Are the signs or symptoms serious, such as hypotension, pulmonary congestion, dizziness, shock, ongoing chest pain, shortness of breath, congestive heart failure, weakness or fatigue, or acute altered mental status?
- Are the signs and symptoms related to the slow heart rate?
- There may be another reason for the patient’s symptoms other than the slow heart rate.
- Decide whether the patient has adequate perfusion. The treatment sequence is determined by the severity of the patient’s clinical presentation.
- If perfusion is adequate, monitor and observe the patient.
- If perfusion is poor, move quickly through the following actions:
- Prepare for transcutaneous pacing. Do not delay pacing. If no IV is present pacing can be first.
- Consider administering atropine 0.5 mg IV if IV access is available. This may be repeated every 3 to 5 minutes up to 3mg or 6 doses.
- If the atropine is ineffective, begin pacing.
- Consider epinephrine or dopamine while waiting for the pacer or if pacing is ineffective.
- Epinephrine 2 to 10 µg/min
- Dopamine 2 to 20 µg/kg per minute
Progress quickly through these actions as the patient could be in pre-cardiac arrest and need multiple interventions done in rapid succession: pacing, IV atropine, and infusion of dopamine or epinephrine.
Author’s bio: https://www.acls.net/judy-bio.html